When to Go to the Emergency Room

Side effects are a common occurrence for people undergoing cancer treatment. Nausea,
vomiting, fatigue, and other physical discomforts are notorious symptoms of chemotherapy
and other cancer therapies. Because of the strength and toxicity required of many
cancer treatments in order to kill cancer cells, most, if not all, patients expect
that they will experience some unpleasant symptoms during and even after treatment.
However, for this reason, many people may not know how to determine when their side
effects are beyond the norm and severe enough to require special medical attention.

All patients should have a clear understanding of when certain side effects, or
escalating or uncontrollable pain, warrant a visit to a hospital emergency room,
or ER. Following surgery, or at the onset of treatment or the start of a new or
increased dosage of a medication, you should have a discussion with your physician
about possible side effects, pain, or other reactions. Make sure you have an idea
of when it is important for you to contact your doctor or seek immediate attention
(such as a fever of 101°F or higher). Often it's better to err on the side of caution,
because sometimes symptoms are easier to treat and can be managed more effectively
earlier rather than later.

If at any time during or after treatment, you experience symptoms other than what
you are expecting, or if you feel much worse than you believe you should, it is
imperative that you seek medical attention immediately. Barbara A. Murphy, MD, associate
professor of Medicine and Director of the Cancer Supportive Care Program at
Vanderbilt-Ingram Cancer Center in Nashville, says side effects are often
expected complications of cancer therapy. "Prior to treatment, the health care staff
will review potential side effects with patients and provide them with medications
that can prevent or treat side effects if they occur." If you experience expected
side effects that are controlled with medications, action may not need to be taken,
she says. However, when and if you develop uncontrolled or unexpected side effects,
such as sudden pain, a rise in temperature, altered mental status, or nausea or
diarrhea that cannot be controlled with medication, a call to the doctor's office
is indicated. "Most cancer doctors have an answering service that is available 24
hours a day, seven days a week specifically for this purpose," Dr. Murphy adds.

Generally, over the phone, your doctor or nurse can then make a determination as
to the best course of action. It may be a medication change that can be made over
the phone. "If, however, the medical staff is concerned that the side effect may
indicate or lead to a severe or life-threatening problem, the patient may be referred
to the emergency room for evaluation," Dr. Murphy says. She also cautions that if
you experience a true medical emergency (such as difficulty breathing or severe
chest pains), you should not wait to contact your physician. "You should proceed
immediately to the ER or call an ambulance if needed. Problems can develop slowly
over time or very quickly."

Signs of Change

You should be aware of changes in pain, symptoms, or other implications in the way
you are feeling. "One of the most important factors with all symptoms, including
pain, affecting the decision to be seen is change," says William Dunson, MD, director,
Huntsman Internal Medicine Acute Care Clinic,
Huntsman Cancer Institute at the University of Utah in Salt Lake City. He
says patients should recognize if the pain or symptom is new or worse, and for cancer
patients, pain such as headache, back pain, and abdominal pain are common symptoms.
"If pain or another symptom is new or is chronic but has gotten worse, you should
start by calling your doctor or nurse," he says, adding that if you can't reach
them because it's after hours or the weekend, you may need to be seen in the emergency
room.

Caregivers should also be well aware of what symptoms are expected and what changes
may indicate a need for immediate care. Sometimes patients are unable or unwilling
to articulate their discomfort or altered status, and therefore caregivers should
have the knowledge they need in order to determine when something needs to be done.

Escalating Symptoms

Dr. Dunson says other common problems such as nausea, vomiting, or diarrhea may
warrant a visit to the emergency room if the patient is suffering from dehydration.
"If they can't keep fluids down or have symptoms of dehydration such as dizziness,
dry mouth, or they feel light-headed especially when changing positions, they may
need to go to the ER," he says.

According to Dr. Dunson and Sloan B. Karver, MD, the program leader in psychosocial
and palliative care at Moffitt Cancer Center
in Tampa, symptoms that warrant a visit to the ER can include:

A single temperature above 101°F or a temperature above 100.4°F for more than 1
hour, especially if you are undergoing chemotherapy

Be Prepared

In the heat of a visit to an emergency room, a plan-ahead strategy will make an
unexpected visit a bit less stressful. "It is good for all patients to keep medical
information in a folder so that they can take it to their office visits as well
as an ER visit," says Suzette Walker, NP, co-director of Symptom Management and
Palliative Care Services at the University
of Michigan Comprehensive Cancer Center in Ann Arbor. "Patients should know
their diagnosis, what they are getting for treatment, and how to contact their health
care providers."

Dr. Dunson adds that a patient should bring a comprehensive list of their medications,
both prescription and over-the-counter. "They should also include the dosage," he
says. "They may also want to bring the actual bottles with them." A detailed medical
history, including what chemotherapy, radiation, and/or surgeries they have received,
is also advisable.

Caregivers can also play an important role in emergency room visits. "If the patient
is confused, or not in a position to speak for themselves, someone familiar with
their medical history should come with them," Dr. Dunson says.

After the Visit

Once you've been seen in the emergency room, your symptoms treated, and you've been
discharged, be sure to follow-up with your cancer doctor. The emergency room staff
should provide you with post-visit instructions, which will include recommendations
on when to contact your regular physician.